Provider Demographics
NPI:1063669521
Name:STONE, SARA COOK (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:COOK
Last Name:STONE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4856
Mailing Address - Country:US
Mailing Address - Phone:985-447-3889
Mailing Address - Fax:985-446-2483
Practice Address - Street 1:404 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4856
Practice Address - Country:US
Practice Address - Phone:985-447-3889
Practice Address - Fax:985-446-2483
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200871363A00000X
LAPA.200871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2488743Medicaid